Imaeda Miho, Tanaka Satoshi, Fujishiro Hiroshige, Kato Saki, Ishigami Masatoshi, Kawano Naoko, Katayama Hiroto, Kohmura Kunihiro, Ando Masahiko, Nishioka Kazuo, Ozaki Norio
Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi 466-8550 Japan ; Sakura Clinic, 5-6 Dankeidori, Showa, Nagoya, Aichi 466-0842 Japan.
Department of Psychiatry, Nagoya University Hospital, 65 Tsurumai, Showa, Nagoya, Aichi 466-8550 Japan.
J Eat Disord. 2016 Dec 7;4:37. doi: 10.1186/s40337-016-0127-x. eCollection 2016.
There are few previous reports regarding the cause and evolution of liver injury in patients with anorexia nervosa (AN) during the refeeding process, and its management remains controversial. This study aimed to determine the risk factors for elevated liver enzymes during refeeding and their effect on the therapeutic process in severely malnourished patients with eating disorders.
In a retrospective cohort study of 167 female inpatients in a single hospital from January 2004 to March 2015, 67 who had normal alanine aminotransferase (ALT) levels on admission were divided into two groups according to the presence or absence of elevated ALT levels during refeeding, and then compared.
The median age and body mass index (BMI) of the patients on admission were 22 [interquartile range (IQR), 16-33] years and 12.2 (IQR, 11.1-13.0) kg/m, respectively. Compared with their cohorts, significantly more patients in the early onset age group (<15 years old) had elevated ALT levels during refeeding (67% vs. 33%, = 0.033), as did patients with longer median time to nadir BMI (3.0 vs. 0 days, = 0.03). In addition, onset age [odds ratio (OR): 0.274; 95% confidence interval (CI): 0.077-0.981; = 0.047] and time to nadir BMI (OR: 1.271; 95% CI: 1.035-1.56; = 0.022) were significantly associated with the odds of elevated ALT levels during refeeding.
The results of this study suggest that early age at onset may be a potential risk factor for elevated ALT levels during refeeding in severely malnourished patients with eating disorders. Furthermore, elevated ALT levels during refeeding were significantly associated with delay in the start of weight gain. No significant relationship was found between the amount of initial prescribed calories and elevated ALT levels during refeeding. The median time to maximum ALT was 27 (IQR, 21-38) days after the refeeding process started.
关于神经性厌食症（AN）患者在重新进食过程中肝损伤的原因及演变，此前报道较少，其治疗仍存在争议。本研究旨在确定严重营养不良的饮食失调患者在重新进食期间肝酶升高的危险因素及其对治疗过程的影响。
在一项对2004年1月至2015年3月期间一家医院167名女性住院患者的回顾性队列研究中，将67名入院时丙氨酸氨基转移酶（ALT）水平正常的患者根据重新进食期间ALT水平是否升高分为两组，然后进行比较。
患者入院时的中位年龄和体重指数（BMI）分别为22岁[四分位间距（IQR），16 - 33岁]和12.2（IQR，11.1 - 13.0）kg/m²。与同组患者相比，发病年龄早（<15岁）的患者在重新进食期间ALT水平升高的比例显著更高（67%对33%，P = 0.033），达到最低BMI的中位时间较长的患者也是如此（3.0天对0天，P = 0.03）。此外，发病年龄[比值比（OR）：0.274；95%置信区间（CI）：0.077 - 0.981；P = 0.047]和达到最低BMI的时间（OR：1.271；95% CI：1.035 - 1.56；P = 0.022）与重新进食期间ALT水平升高的几率显著相关。
本研究结果表明，发病年龄早可能是严重营养不良的饮食失调患者在重新进食期间ALT水平升高的一个潜在危险因素。此外，重新进食期间ALT水平升高与体重增加开始延迟显著相关。重新进食期间初始规定热量的量与ALT水平升高之间未发现显著关系。ALT达到最高值的中位时间是在重新进食过程开始后的27天（IQR，21 - 38天）。
